AN INCREDIBLE GIFT

Dr. Myp Sekhon remembers the 19-year-old boy as “calm, collected, very strong.”

His mother had just died at St. Paul’s Hospital. She had Crohn’s disease and was in hospital after surgery when her heart stopped beating.

Doctors resuscitated her and rushed her to ICU, but she never woke up – her brain had been deprived of oxygen for too long. On the third day, doctors pronounced her brain-dead. She was 42.

The boy’s dad had passed away some years before. His grandmother, his mom’s mom, had just died four months prior.

He had no aunts, no uncles, no cousins, no brothers, no sisters.

“He was left still dealing with his grandmother’s estate, and now having lost his mom, his last relative, I can’t imagine how tragic a time it was for him,” Sekhon recalled.

Sekhon broached the topic of organ donation. Is it something you have talked about with your mom?

It wasn’t, said the teen. I have no idea.

Hospital staff checked with B.C. Transplant. They found the woman was a registered donor. A copy of her registration was faxed to the hospital.

When Sekhon talked to the son again, the teen had already decided to consent to donation. But seeing the document – signed in her own hand in 2000 when he was only seven years old – eased the burden of responsibility.

Transplant donation stories in the media tend to have a happy ending. An organ has been found; a life has been saved.

But before a recipient’s pager beeps and a life-changing operation begins, someone has to die a sudden, traumatic death.

A St. Paul’s ICU doctor since 1994, Greg Grant has witnessed many such deaths and had countless conversations about organ donation.

The generosity and grace exhibited by the families never ceases to amaze him: “You have these people going through the worst time of their lives, and one of their driving things is: ‘If I can help another mother not go through this, that is my job.'”

When Grant took over as provincial director of B.C. Trans-plant two years ago, his goal was to increase awareness of organ donation, especially deceased donations, with better training and support of ICU doctors.

“That was where I came in. That was my home turf,” he said. “It’s a tough dynamic. But we’re getting better at asking.”

In the past two years B.C. has doubled the number of deceased donations.

In 2011, 70 deceased donors gave their priceless gifts to 277 people.

TRANSPLANTS BY THE NUMBERS

A chart of the number of transplants in B.C. this year.

2012 donations St. Paul’s

Kidney – deceased donor 86 51

Kidney – living donor 51 30

Pancreas-kidney 2 0

Pancreas 2 0

Pancreas – islet 1 0

Liver – deceased donor 44 0

Liver – living donor 5 0

Heart 11 11

Single lung 3 0

Double lung 18 1

Total 223 93

WAITING LIST: HOW LONG IT TAKES

Wait lists in 2011 for deceased donor transplants:

Kidney: 62 months

Pancreas-kidney: 44 months

Pancreas: 35 months

Lungs: 11 months

Liver: Two months

Heart: Less than a month

– Source: B.C. Transplant

“At some point, when there is no hope somebody will get better, it is important we ask families about donations,” said Grant. “If you ask and they say no, that’s a fine answer. It’s not as if I’d go, ‘Come on, we got this patient on the wait list.’ It is not our job to talk them into it.”

In all his years of asking, nobody has been offended.

“I don’t want to sell donation,” he said. “I want it as an option for people who believe in it.”

Despite the success, many patients wait in vain.

About 450 people are waiting for a transplant in B.C. Last year, eight people died on the wait list.

B.C. has a good track record in living kidney donations, which are considered safe.

Patients with damaged hearts can go on a ventricular assist device, essentially a mechanical heart, while waiting for a transplant.

Liver and lung patients have fewer options. Living donation is possible, but risky and rare.

New technology such as the Novalung, an artificial lung, can only be used short-term.

Currently, almost 850,000 British Columbians – or 19 per cent of the population – are registered on the B.C. Transplant donor registry.

But polls show 85 per cent of Canadians support transplants and donations. When doctors get down to asking, about 50 to 60 per cent say yes, said Grant.

Statistics show people have a higher likelihood of needing an organ than of qualifying as a donor.

Up until recently in Canada, organs can only be recovered from patients who have been declared brain-dead. Brain death accounts for no more than four per cent of all in-hospital deaths.

In 2006, Canada began allowing organ donation after cardiac death, where death is pronounced based on cardio-respiratory criteria rather than neurological.

The first donation by cardiac death occurred in Ottawa in 2006. The first in Western Canada took place at St. Paul’s Hospital in 2008.

The protocol is now recognized at Vancouver General Hospital and Royal Columbian Hospital and will soon be in place in Victoria, Surrey and Kelowna.

B.C. Transplant is also exploring other methods to increase awareness. It has come out in support of a new Facebook initiative launched last week enabling Canadians to identify themselves as donors on their profile page.

It has placed co-ordinators trained to approach families about donation at Vancouver General and Royal Columbian hospitals – Metro Vancouver’s major trauma hospitals – as well as in hospitals in Victoria and soon, Kelowna.

It’s also looking into letting potential donors leave a video message for their loved ones, explaining their decision.

In Canada, express consent is the norm. But lengthening wait lists have raised issues whether consent laws should be changed.

Spain, which has the highest rate of organ donation in the world, operates on implied consent.

Everyone is assumed to be a willing organ donor.

A patient with no chance of survival would be put on life-prolonging treatment to protect the viability of organs, while waiting for consent from the family, explained Grant. Spain also has a highly organized system of donor management.

In the U.K., presumed consent was proposed a few years ago. Registration would be mandatory, with an opt-out.

Presumed consent worries Grant because it appears to take away the gift-giving aspect of donation.

“If I give to a charity, it makes me feel really good,” he said. “I don’t feel the same way about taxes. We might have more organs, but this is such an incredible gift, and we might lose that on the other end if we make it a mandatory process.”

REGISTER TO DONATE

To register on the organ donor registry:

? Go online at transplant.bc.ca where you can register online, download a PDF, or request a brochure to be mailed to you.

? Registration cards are at motor vehicle branches, London Drugs, ICBC Autoplan brokers, claim centres, doctor’s offices and some pharmacies.

The forms ask the individual to provide consent to donate organs for transplant and/or research purposes. Registrants are able to select organs they do not want donated. Registrants can also tick off a box that says they do not want to be a donor.

The forms are scanned into a secure computerized database at B.C. Transplant. Hospital staff can access the registry through a secure website connected to the patient’s B.C. CareCard number at the time of death.

If the individual has registered, a copy can be sent to hospital to be shown to family.

-Source: B.C. Transplant